[Prevention and therapy of infections in tumor patients]

The neutropenic patient with fever remains a great challenge. Because of the high risk of life-threatening bacterial infections, all febrile neutropenic patients should be treated with broad-spectrum bactericidal antibiotics promptly by the intravenous route and in maximal therapeutic dosages. Although the currently available diagnostic tests are not sufficiently rapid, sensitive, or specific for identifying or excluding the microbial cause of a febrile episode, a careful diagnostic work-up should be done. The concern about the problem of emerging drug resistance bacteria due to extensive antibiotic use, plus the fact that such prophylaxis has not been shown to reduce mortality rates, led to the recommendation that routine prophylaxis with these antibiotics in neutropenic patients be avoided. Vaccination should be emphasized in these patients.